Heart failure is an enormous public health problem in the United States. Over the past two decades, there has been considerable progress in the treatment of chronic heart failure yet, even with the best of modern therapy, heart failure is stil associated with a 5-year mortality rate of 50%. Therefore, the search for new approaches to treatment and prevention of heart failure is one of the major challenges in medicine. The ATP-sensitive potassium (KATP) channel, one of the most abundant cardiac membrane protein complexes, has the unique ability to adjust membrane excitability in response to changes in the energetic status of the cell. When activated by increased cellular metabolic demand, KATP channel-dependent potassium efflux shortens cardiac action potential duration (APD). This potassium efflux limits sodium and calcium entry into the cell and thus reduces energy requirements for ion homeostasis and contraction, as well as prolongs the diastolic interval that supports myocardial relaxation and replenishment of ATP. Our recent work uncovered that that the ability of the heart to optimize APD and energy utilization depends on the membrane expression level of KATP channels which affects how quickly and efficiently KATP current can adapt to changes in workload. A complete understanding of mechanisms that control membrane KATP channel expression may reveal new avenues to promote cardiac energy efficiency and resistance to heart failure. Based on our preliminary data, we hypothesize that membrane KATP channel expression is coupled with overall cardiac function by calcium/calmodulin dependent protein kinase II (CaMKII). This densely expressed multifunctional kinase targets numerous proteins involved in excitation contraction coupling and excitability to support enhanced cardiac performance, while its persistent activation under pathophysiological conditions promotes cardiomyocyte death and dysfunction. We propose a previously unrecognized downstream signaling pathway of CaMKII activation through phosphorylation of the Kir6.2 pore-forming KATP channel subunit and consequent endocytosis of KATP channels. Under persistent CaMKII activation, the consequent reduction in KATP channel expression would aggravate depletion of cardiac energy resources thus contributing to myocardial injury, cell death and heart failure. We predict that the known beneficial effects on cardiac stress resistance that occur with CaMKII inhibition will depend significantly on membrane retention of KATP channels. In Aim1 we will define the mechanism for CaMKII-dependent endocytosis of KATP channels by use of tagged recombinant KATP channel subunits, confocal immunofluorescence imaging, and molecular biology and patch clamp techniques in cardiomyocytes and HEK293T cells. In Aim 2 we will study heart failure, induced in genetic mouse models with KATP channel expression deficits and cardioselective CaMKII inhibition, to understand the role of CaMKII-dependent KATP channel expression regulation in the generation of the energetic and functional deficits defining heart failure. PUBLIC HEALTH RELEVANCE: Heart failure is an enormous public health problem in the United States where the incidence and mortality are high such that the search for new approaches to treatment and prevention is one of the major challenges in medicine. Membrane expression of KATP channels affects optimization of cardiac energy consumption and resistance to injury. This project will define a novel mechanism for control of KATP channel membrane expression, and will determine the potential for its manipulation in improvement of myocardial energetics and heart failure resistance.